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Sugarbaker PH, Chang D. Long-term regional chemotherapy for patients with epithelial malignant peritoneal mesothelioma results in improved survival. Eur J Surg Oncol 2017; 43:1228-1235. [PMID: 28189456 DOI: 10.1016/j.ejso.2017.01.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/16/2016] [Accepted: 01/10/2017] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Malignant peritoneal mesothelioma (MPM) is a rare disease with about 300 new cases per year in the USA. Its natural history is described as local progression within the peritoneal space in the absence of liver metastases or systemic disease. METHODS Cytoreductive surgery (CRS) is a series of peritonectomy procedures and visceral resections with a goal of complete removal of all visible disease from the abdomen and pelvis. Over 20 years, three protocols investigating increasing efficacy of additional chemotherapy treatments added to CRS have been initiated. Initially, hyperthermic perioperative chemotherapy (HIPEC) with doxorubicin and cisplatin was used in the operating room. Then, early postoperative intraperitoneal chemotherapy (EPIC) with paclitaxel was added for the first 5 days after CRS. The third protocol employed HIPEC, then EPIC, and then long-term intraperitoneal (IP) paclitaxel or IP pemetrexed plus intravenous (IV) cisplatin as a adjuvant normothermic intraperitoneal chemotherapy (NIPEC). RESULT The 5-year survival of 42 patients treated with CRS and HIPEC was 44%, for 58 patients treated with EPIC and HIPEC was 52% and 29 patients who received HIPEC, EPIC, and NIPEC was 75% (p = 0.0374). Prognostic variables of age, gender, treatment administered, peritoneal cancer index (PCI) and completeness of cytoreduction were significant by univariate analysis and treatments administered and completeness of cytoreduction significant by multivariate analysis. CONCLUSIONS Long-term regional chemotherapy was associated with improved survival in patients with MPM. In this rare disease, additional phase 2 investigations are suggested.
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Welsh AW, Maheshwari P, Wang J, Henry A, Chang D, Crispi F, Gardiner HM, Hernandez-Andrade E, Meriki N, Redmond S, Yagel S. Evaluation of an automated fetal myocardial performance index. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:496-503. [PMID: 26423314 DOI: 10.1002/uog.15770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/17/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare automated measurements of the fetal left myocardial performance index (MPI) with manual measurements for absolute value, repeatability and waveform acceptability. METHODS This was a multicenter international online study using images from uncomplicated, morphologically normal singleton pregnancies (16-38 weeks' gestation). Single Doppler ultrasound cardiac cycle images of 25 cases were selected, triplicated and randomized (n = 75). Six senior observers, unaware of the repetition of images, manually calculated MPI for each waveform and the results were compared with automation. Intraobserver repeatability and interobserver reproducibility were assessed using intraclass correlation coefficients (ICCs) and 95% CI. The agreement between each observer's manual MPI measurements and corresponding automated measurements was evaluated using Bland-Altman plots and ICCs with 95% CI. The degree of variation between experts in the classification of fetal MPI waveform quality was assessed using individual cardiac cycle left MPI images previously classified by two authors as 'optimal', 'suboptimal' or 'unacceptable', with 30 images selected for each quality group. Ten images in each category were duplicated and the resulting 120 images were randomized and then classified online by five observers. The kappa statistic (κ) was used to demonstrate interobserver and intraobserver agreement and agreement of classifications by the five observers. RESULTS The automated measurement software returned the same value for any given image, resulting in an ICC of 1.00. Manual measurements had intraobserver repeatability ICC values ranging from 0.69 to 0.97, and the interobserver reproducibility ICC was 0.78. Comparison of automated vs manual MPI absolute measurements for each observer gave ICCs ranging from 0.77 to 0.96. Interobserver image quality classification agreement gave k = 0.69 (P < 0.001), and the intraobserver agreement was variable (κ ranging from 0.40 to 0.81). CONCLUSIONS Automated fetal MPI provides superior repeatability and reproducibility to manual methodology. Additionally, experts vary significantly when classifying suitability of fetal MPI waveforms. Automated MPI may facilitate clinical translation by removing human subjectivity. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Gallais Sérézal I, Cheuk S, Chang D, Eidsmo L. 365 Activation of resident T cells in a human ex-vivo model induces tissue responses in resolved psoriasis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Duan X, Cui Y, Li H, Shi G, Wu B, Liu M, Chang D, Wang T, Kong Y. High preoperative and postoperative levels of carcinoembryonic antigen and CYFRA 21-1 indicate poor prognosis in patients with pathological Stage I nonsmall cell lung cancer. Indian J Cancer 2016; 52 Suppl 3:E158-63. [PMID: 27453414 DOI: 10.4103/0019-509x.186564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Serum carcinoembryonic antigen (CEA) and the soluble fragment of cytokeratin 19 (CYFRA 21-1) are supposed to have a prognostic role in patients with nonsmall cell lung cancer (NSCLC) after surgery, but it has not been used as an adjunct to the tumor-node-metastasis (TNM) staging system to provide therapy options for patients with pathological Stage I NSCLC. This study was designed to investigate the effect of serum levels of CEA and CYFRA 21-1 before and after surgery on the prognosis of patients with Stage I NSCLC. MATERIALS AND METHODS A retrospective review was performed regarding the medical records and follow-ups of 169 patients with Stage I NSCLC before and after surgery. The patients were divided into three groups based on levels of serum CEA and CYFRA 21-1 before and after surgery: (1) continuously normal-level groups (CEA [NN] and CYFRA 21-1 [NN] groups); (2) declined to normal-level groups (CEA [HN] and CYFRA 21-1 [HN] groups); and (3) continuously high-level groups (CEA [HH] and CYFRA 21-1 [HH] groups). Survival analysis was conducted using the Kaplan-Meier method for each group. The Chi-square or Fisher exact test was employed to compare clinical and pathologic factors at the level of P < 0.05. The prognostic factor was evaluated by the Cox proportional hazards model. RESULTS Compared with the continuously normal-level groups, the CEA [HN] group was significantly correlated to tumor size (P = 0.011), and the CYFRA 21-1 [HN] group was significantly correlated to tumor type and pathological TNM in addition to tumor size. Five-year survivals were significantly lower (P = 0.004) in the CEA [HH] group (67.3%) and the CEA [HN] group (86.5%) than in the CEA [NN] group (85.7%) and were significantly lower (P < 0.001) in the CYFRA 21-1 [HH] group (47.2%) and the CYFRA 21-1 [HN] group (70.1%) than in the CYFRA 21-1 [NN] group (90.1%). Multivariate analysis demonstrated that tumor size (21-50 mm), CEA [HH], and CYFRA 21-1 [HH] were independent unfavorable prognostic factors for overall survival (OS), whereas tumor size (21-50 mm), CEA [HH], CYFRA 21-1 [HN], and CYFRA 21-1 [HH] were independent significant prognostic factors for progression-free survival (PFS). CONCLUSION Patients with a persistently high serum CEA or CYFRA 21-1 before and after surgery had shortest OS and PFS. These patients had worst prognosis. Adjuvant chemotherapy was likely to improve survival for these patients.
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Chen LT, Siveke J, Wang-Gillam A, Hubner R, Pant S, Dragovich T, Chung V, Chang D, Ross P, Cooray P, Tebbutt N, Franke F, Belanger B, Dhindsa N, de Jong F, Mamlouk K, Von Hoff D. PD-023 Safety across subgroups in NAPOLI-1: a phase 3 study of nal-IRI (MM-398) ± 5-fluorouracil and leucovorin (5-FU/LV) versus 5-FU/LV in metastatic pancreatic cancer (mPAC) previously treated with gemcitabine-based therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw200.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Patel J, Kittleson M, Czer L, Aintablian T, Stimpson E, Daun T, Manayan T, Rodriguez G, Chang D, Ramzy D, Kobashigawa J. Chronic Lung Disease Fev1/Fvc <70% and Primary Graft Dysfunction; a Marker for Prolonged Intubation Immediately Post-Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cheng R, Azarbal B, Vanichsarn C, Patel J, Chang D, Kittleson M, Kobashigawa J. Cardiac Allograft Donor Age Is Associated with Increased Baseline Coronary Plaque Burden but Not with Its Progression as Assessed by Intravascular Ultrasound. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kobashigawa J, Kittleson M, Patel J, Aintablian T, Zarrini P, Lipson A, Kao T, Daun T, Chang D, Trento A, Hage A, Czer L. Thymoglobulin Provides Protection Against Ischemia Reperfusion in the Immediate Post-Transplant Period. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Luu M, Patel J, Kittleson M, Czer L, Aintablian T, Norland K, Perry N, Chang D, Hamilton M, Geft D, Kobashigawa J. Lower Dose Tacrolimus Monotherapy in Heart Transplant Patients: Is It Safe. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kittleson M, Patel J, Czer L, Aintablian T, Rodriguez G, Velleca A, Kearney B, Chang D, Hamilton M, Esmailian F, Zhang X, Reinsmoen N, Kobashigawa J. Proliferation Signal Inhibitors Prevent Donor-Specific Antibody Production in Sensitized Patients after Heart Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Runyan C, Henry H, Huie N, Moriguchi J, Kittleson M, Czer L, Chang D, Passano E, Aintablian T, Kobashigawa J, Esmailian F, Arabia F. Can Patients with Restrictive Physiology Be Successfully Bridged to Transplant with Left Ventricular Support Alone Versus Biventricular Support? J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sogomonian R, Alkhawam H, Lee S, Chang D, Moradoghli Haftevani EA. ID: 6: HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY IN THE SETTING OF SYSTEMIC SCLERODERMA. J Investig Med 2016. [DOI: 10.1136/jim-2016-000120.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Restrictive cardiomyopathy has been a common variant seen in systemic sclerosis (SS) with myocardial fibrosis. The association of SS with restrictive cardiomyopathy has well been established, but that with HOCM is not clearly understood. Herein, we report a case of a patient with SS, identified to have both HOCM and myocardial fibrosis.A 54-year-old woman with systemic sclerosis, idiopathic lung disease with moderate pulmonary hypertension, presented with fatigue, decreased appetite and shortness of breath. Vital signs were significant for oxygen saturation of 86% on room air, tachycardia of 117 bpm, and blood pressure of 110/53 mm Hg. Physical examination revealed diffuse rhonchi in all lung fields, malar rash and skin excoriation in bilateral lower extremities without edema. Laboratory studies were significant for elevated brain natriuretic peptide (BNP) of 858 pg/mL. Transthoracic echocardiography revealed left ventricular hypertrophy (LVH) with ejection fraction of 78%. Electrocardiography illustrated LVH. Cardiac magnetic resonance imaging (cMRI) was significant for severe left ventricular cardiac asymmetric septal hypertrophy with outflow obstruction caused by anterior motion of the mitral valve. Cardiac biopsy revealed evidence of diffuse fibrosis, but did not show iron, glycogen, or amyloid depositions.Patient was maintained on mycophenolate mofetil, low dose of methylprednisolone, morphine, clonazepam and transferred to hospice care.Hypertrophic obstructive cardiomyopathy (HOCM) is the most common genetic cardiac disorder with an autosomal dominant transmission. It is characterized by asymmetric LVH out of proportion of systemic after load. The most common cardiac involvement in SS is myocardial fibrosis in a restrictive pattern, while HOCM is rarely seen in SS.Abstract ID: 6 Figure 1Cardiac MRI demonstrating hypertrophied ventricle with fibrosis. This image demonstrates the features of both hypertrophic and restrictive cardiomyopathy.
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Kittleson M, Patel J, Czer L, Passano E, Aintablian T, Runyan C, Huie N, Chang D, Esmailian F, Moriguchi J, Kobashigawa J. Comparison of 6 Month Hospitalizations in Mechanical Circulatory Support Patients vs Heart Transplant Patients. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Patel J, Kittleson M, Czer L, Aintablian T, Johl M, Daun T, Kearney B, Chang D, Azarbal B, Hamilton M, Esmailian F, Kobashigawa J. Does ACE Inhibitor Use in Heart Transplantation Decrease the Development of Cardiac Allograft Vasculopathy? J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Rohde M, Peeters JWR, Pucciarelli A, Kiss A, Rao YF, Onder EN, Muehlbauer P, Batta A, Hartig M, Chatoorgoon V, Thiele R, Chang D, Tavoularis S, Novog D, McClure D, Gradecka M, Takase K. A Blind, Numerical Benchmark Study on Supercritical Water Heat Transfer Experiments in a 7-Rod Bundle. JOURNAL OF NUCLEAR ENGINEERING AND RADIATION SCIENCE 2016. [DOI: 10.1115/1.4031949] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heat transfer in supercritical water reactors (SCWRs) shows a complex behavior, especially when the temperatures of the water are near the pseudocritical value. For example, a significant deterioration of heat transfer may occur, resulting in unacceptably high cladding temperatures. The underlying physics and thermodynamics behind this behavior are not well understood yet. To assist the worldwide development in SCWRs, it is therefore of paramount importance to assess the limits and capabilities of currently available models, despite the fact that most of these models were not meant to describe supercritical heat transfer (SCHT). For this reason, the Gen-IV International Forum initiated the present blind, numerical benchmark, primarily aiming to show the predictive ability of currently available models when applied to a real-life application with flow conditions that resemble those of an SCWR. This paper describes the outcomes of ten independent numerical investigations and their comparison with wall temperatures measured at different positions in a 7-rod bundle with spacer grids in a supercritical water test facility at JAEA. The wall temperatures were not known beforehand to guarantee the blindness of the study. A number of models have been used, ranging from a one-dimensional (1-D) analytical approach with heat transfer correlations to a RANS simulation with the SST turbulence model on a mesh consisting of 62 million cells. None of the numerical simulations accurately predicted the wall temperature for the test case in which deterioration of heat transfer occurred. Furthermore, the predictive capabilities of the subchannel analysis were found to be comparable to those of more laborious approaches. It has been concluded that predictions of SCHT in rod bundles with the help of currently available numerical tools and models should be treated with caution.
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Jiang H, Cui Y, Ma K, Gong M, Chang D, Wang T. Experimental reconstruction of cervical esophageal defect with artificial esophagus made of polyurethane in a dog model. Dis Esophagus 2016; 29:62-9. [PMID: 25074403 DOI: 10.1111/dote.12258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The defect of esophagus after surgical excision in patients is usually replaced by autologous stomach, jejunum, or colon. The operation brings severe trauma and complications. Using artificial esophagus to replace the defect in situ can reduce the operative trauma, simplify the operative procedures, and decrease the influence to digestive function. A variety of experiments have been designed for developing a practical artificial esophagus. Nevertheless, a safe and reliable artificial esophagus is not yet available. The objective is to evaluate the possibility of the artificial esophagus made of non-degradable polyurethane materials being used in reconstruction of the segmental defect of cervical esophagus in beagles, observe the regeneration of esophageal tissue, and gather experience for future study. The cervical esophageal defects in 13 beagles were designed to 2-cm long and were constructed by the artificial esophagus made of non-degradable polyurethane materials. Nutrition supports were given after the operation. The operative mortality, anastomotic leakage, migration of artificial esophagus, and dysphagia were followed up. The regeneration of the esophageal tissues was evaluated by histopathology and immunohistochemical labeled streptavidin-biotin method. The surgical procedures were successfully completed in all beagles, and 12-month follow-ups were done. Only one beagle died of severe infection, and all others survived until being killed. The anastomotic leakage occurred in nine beagles, most of them (8/9) were cured after supportive therapy. The migration of artificial esophagus occurred in all 12 surviving beagles, and one artificial esophagus stayed in situ after migration. All 12 surviving beagles showed dysphagia with taking only fluid or soft food. No beagle died of malnutrition. The neo-esophagus was composed of granulation tissue, and the inner surface was covered by epithelium in 2-3 months completely. But the inner surface of neo-esophagus with artificial esophagus staying in situ after migration was not covered by epithelium, and the granulation tissue was infiltrated by a great deal of inflammatory cells. Antibodies against cytokeratin were positively expressed in epithelium of neo-esophagus. Up to 12 months after operation, antibodies against smooth muscle actin and desmin were both negatively expressed in neo-esophagus. The artificial esophagus made of non-degradable polyurethane reconstructing cervical esophageal defect is practicable. Although there are some problems, including anastomotic leakage, migration, and dysphagia, they are not lethal following good supportive therapy. The esophageal epithelium can regenerate with the supporting role of artificial esophagus. In the future, deformable artificial esophagus should be improved, and a much longer follow-up will be performed to evaluate whether the esophageal gland and skeletal muscle can regenerate.
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Wilson A, Chang D, Alley M, Chera B, Mazur L, Comitz E, Deschesne K, Mosaly P, Taylor K, Rockwell J, Terzo L, Neuvirth K, Stravers L, Hoyle L, Tracton G, Adams R. The Stringency of Portal Film Approval: An In-House Retrospective Analysis of Regular Versus Cross-Coverage Variances in Radiation Oncology. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liu X, Ren G, Xia T, Di Y, Chang D. Dosimetric Predictors for Gastrointestinal Toxicity in Pancreatic Cancer After Hypofractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chang D, Alley M, Adams R, Wilson A, Church J, Comitz E, Deschesne K, Mosaly P, Taylor K, Johnson K, Terzo L, Rockwell J, Neuvirth K, Stravers L, Hoyle L, Tracton G, Mazur L, Marks L, Chera B. Enhancing Patient Safety Mindfulness and Promoting a Safety Culture in Radiation Oncology Through the Use of an Event Learning System (ELS). Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Borggrefe J, Giravent S, Campbell G, Thomsen F, Chang D, Franke M, Günther A, Heller M, Wulff A. Association of osteolytic lesions, bone mineral loss and trabecular sclerosis with prevalent vertebral fractures in patients with multiple myeloma. Eur J Radiol 2015; 84:2269-74. [PMID: 26283192 DOI: 10.1016/j.ejrad.2015.07.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/16/2015] [Accepted: 07/27/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE In patients with multiple myeloma (MM), computed tomography is widely used for staging and to detect fractures. Detecting patients at severe fracture risk is of utmost importance. However the criteria for impaired stability of vertebral bodies are not yet clearly defined. We investigated the performance of parameters that can be detected by the radiologist for discrimination of patients with and without fractures. METHODS AND MATERIALS We analyzed 128 whole body low-dose CT of MM patients. In all scans a QCT calibration phantom was integrated into the positioning mat (Image Analysis Phantom(®)). A QCT-software (Structural Insight) performed the volumetric bone mineral density (vBMD) measurements. Description of fracture risk was provided from the clinical radiological report. Suspected progressive disease (PD) was reported by the referring clinicians. Two radiologists that were blinded to study outcome reported on the following parameters based on predefined criteria: reduced radiodensity in the massa lateralis of the os sacrum (RDS), trabecular thickening and sclerosis of three or more vertebrae (TTS), extraosseous MM manifestations (EOM), visible small osteolytic lesions up to a length of 8mm (SO) and osteolytic lesions larger than 8mm (LO). Prevalent vertebral fractures (PVF) were defined by Genant criteria. Age-adjusted standardized odds ratios (sOR) per standard deviation change were derived from logistic regression analysis and area under the curve (AUC) from receiver operating characteristics (ROC) analyses were calculated. ROC curves were compared using the DeLong method. RESULTS 45% of the 128 patients showed PVF (29 of 75 men, 24 of 53 women). Patients with PVF were not significantly older than patients without fractures (64.6 ± 9.2 vs. 63.3 ± 12.3 years: mean ± SD, p=0.5). The prevalence of each parameter did not differ significantly by sex. Significant fracture discrimination for age adjusted single models was provided by the parameters vBMD (OR 3.5 [1.4-8.8], AUC=0.64 ± 0.14), SO (sOR 1.6[1.1-2.2], AUC=0.63 ± 0.05), LO (sOR 2.1[1.1-4.2] AUC=0.69 ± 0.05) and RDS (sOR 2.6[1.6-4.7], AUC=0.69 ± 0.05). Multivariate models of these four parameters showed a significantly stronger association with the development of PVF (AUC=0.80 ± 0.04) than single variables. TTS showed a significant association with PVF in men(sOR 1.5 [0.8-3.0], AUC=0.63 ± 0.08), but not in women (sOR 2.3[1.4-3.7], AUC=0.70 ± 0.07). PD was significantly associated with PVF in women (sOR 1.9[1.1-3.6], AUC=0.67 ± 0.08) but not in men (sOR 1.4[0.9-2.3], AUC=0.57 ± .07). EOM were not associated with PVF (sOR 1.0[0.4-2.6], AUC=0.51 ± .05). CONCLUSION In multiple myeloma, focal skeletal changes in low dose CT scans show a significant association with prevalent vertebral fractures. The combination of large osteolytic lesions and loss in radiodensity as can be detected with simple CT Hounsfield measurements of the os sacrum or BMD measurements showed the strongest association to fractures and may be of value for prospective studies.
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Mathias S, Berry P, deVries J, Askanase A, Pascoe K, Colwell H, Chang D. FRI0339 Development of a Novel Patient Reported Outcome (PRO) Measure: The Systemic Lupus Erythematosus (SLE) Steroid Questionnaire (SSQ):. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mathias S, Berry P, deVries J, Askanase A, Pascoe K, Colwell H, Chang D. FRI0370 Development of Two Novel Patient Reported Outcome (PRO) Measures: The Systemic Lupus Erythematosus (SLE) Symptom Severity Diary (SSD) and Sle Impact Questionnaire (SIQ):. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cui Y, Song J, Pollom E, Shirato H, Chang D, Koong A, Li R. TU-CD-BRB-08: Radiomic Analysis of FDG-PET Identifies Novel Prognostic Imaging Biomarkers in Locally Advanced Pancreatic Cancer Patients Treated with SBRT. Med Phys 2015. [DOI: 10.1118/1.4925593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Slebocki K, Kraus B, Chang D, Maintz D, Bangard C. Zufallsbefunde im Rahmen der Dual Source CT des Abdomens: Korrelation zwischen echt-nativen und virtuell-nativen Bildern zur Beurteilung von Nebennierenraumforderungen, Nieren- und Leberzysten. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Seto SW, Yang GY, Kiat H, Bensoussan A, Kwan YW, Chang D. Diabetes Mellitus, Cognitive Impairment, and Traditional Chinese Medicine. Int J Endocrinol 2015; 2015:810439. [PMID: 26060494 PMCID: PMC4427766 DOI: 10.1155/2015/810439] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/15/2015] [Indexed: 12/30/2022] Open
Abstract
Diabetes mellitus (DM) is a metabolic disorder affecting a large number of people worldwide. Numerous studies have demonstrated that DM can cause damage to multiple systems, leading to complications such as heart disease, cancer, and cerebrovascular disorders. Numerous epidemiological studies have shown that DM is closely associated with dementia and cognition dysfunction, with recent research focusing on the role of DM-mediated cerebrovascular damage in dementia. Despite the therapeutic benefits of antidiabetic agents for the treatment of DM-mediated cognitive dysfunction, most of these pharmaceutical agents are associated with various undesirable side-effects and their long-term benefits are therefore in doubt. Early evidence exists to support the use of traditional Chinese medicine (TCM) interventions, which tend to have minimal toxicity and side-effects. More importantly, these TCM interventions appear to offer significant effects in reducing DM-related complications beyond blood glucose control. However, more research is needed to further validate these claims and to explore their relevant mechanisms of action. The aims of this paper are (1) to provide an updated overview on the association between DM and cognitive dysfunction and (2) to review the scientific evidence underpinning the use of TCM interventions for the treatment and prevention of DM-induced cognitive dysfunction and dementia.
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